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Dose of cigarette smoking and clinical course of chronic kidney disease Observational studies assessing clinical characteristics as potential accelerators of progression of autosomal dominant polycystic kidney disease (ADPKD) reported that (a) patients with established proteinuria (more than 300 mg/day) had more pack years and a more severe aggressive clinical course (larger renal volumes, lower creatinine clearances) than their nonproteinuric counterparts [28] and (b) patients with a history of severe smoking (high number of pack years) had higher protein excretion rates and a more rapid progression of ADPKD [29]